a nurse assesses the closed chest tube drainage system of a client who underwent lobectomy 24 hours ago the nurse notes that there has been no chest t
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Nursing Elites

HESI RN

RN Medical/Surgical NGN HESI 2023

1. A client who underwent lobectomy 24 hours ago has not had any chest tube drainage for the past hour. What should the nurse do first?

Correct answer: B

Rationale: When a chest tube is not draining, the nurse's initial action should be to check for kinks or clots in the chest drainage system. This step helps to ensure the patency of the system and allows for proper drainage. Checking the client's blood pressure and heart rate is important but not the priority when addressing a lack of chest tube drainage. Contacting the physician is warranted if signs of respiratory distress or mediastinal shift are observed after ruling out kinks or clots. Connecting a new drainage system is done when the fluid chamber is full, following a specific procedure to maintain a closed system and prevent complications.

2. What should the nurse do before an echocardiogram for a client who has had a myocardial infarction?

Correct answer: D

Rationale: The correct answer is to inform the client that the echocardiogram is a painless procedure that usually takes 30 to 60 minutes to complete. Echocardiography is a noninvasive, risk-free, and pain-free test that uses ultrasound to evaluate the heart's structure and motion. There is no need for special preparation before the procedure. Choices A, B, and C are incorrect because imposing nothing-by-mouth status, obtaining informed consent, and assessing for allergies to iodine or shellfish are not necessary steps before an echocardiogram.

3. A nurse cares for a client with diabetes mellitus who is prescribed metformin (Glucophage) and is scheduled for an intravenous urography. Which action should the nurse take first?

Correct answer: A

Rationale: Metformin can cause lactic acidosis and renal impairment as the result of an interaction with the dye. This drug must be discontinued for 48 hours before the procedure and not started again after the procedure until urine output is well established. The client’s health care provider needs to provide alternative therapy for the client until the metformin can be resumed. Keeping the client NPO, checking the client’s blood glucose, and administering intravenous fluids should be part of the client’s plan of care, but are not the priority, as the examination should not occur while the client is still taking metformin.

4. A client is scheduled for a barium swallow (esophagography) in 2 days. The nurse, providing preprocedure instructions, should tell the client to:

Correct answer: B

Rationale: The correct answer is B: 'Remove all metal and jewelry before the test.' Before a barium swallow procedure, the client should fast for 8 to 12 hours to ensure the stomach and intestines are empty for optimal visualization. Removing all metal and jewelry is essential to prevent any interference with x-ray imaging. Choice A is incorrect because the client should fast, not eat supper and breakfast, before the test. Choice C is incorrect as diarrhea is not an expected outcome of a barium swallow. Choice D is incorrect as the client should not take any oral medications with milk on the day of the test to ensure accurate test results.

5. A client has pyelonephritis and expresses embarrassment about discussing symptoms. How should the nurse respond?

Correct answer: C

Rationale: When a client expresses embarrassment or discomfort in discussing symptoms related to sensitive topics like elimination and the genitourinary area, the nurse should respond by encouraging the client to use words they are comfortable with. This helps the client feel more at ease and opens up communication. Offering a nurse of the same gender may not address the client's discomfort with discussing symptoms. Assuring confidentiality is important, but it should not be promised in a way that may not be fulfilled. Avoiding the topic of elimination entirely does not address the client's feelings or promote effective communication.

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